NR 439 Discussion Search for Literature and Levels of Evidence

NR 439 Discussion Search for Literature and Levels of Evidence

NR 439 Discussion Search for Literature and Levels of Evidence

Nursing research is a dynamic process that includes multiple phases: defining the research problem; literature review; selecting a theoretical framework; choosing an appropriate design; defining a sampling strategy; collecting and analyzing data; sharing the findings, and using the evidence in practice.

The Course Outcomes (COs) we will apply in Week 2 include: 

Examine the sources of evidence that contribute to professional nursing practice.
Apply research principles to the interpretation of the content of published research studies.

Reflect on your practice, and identify a significant nursing clinical issue or change project that you would like to search for evidence in online sources. Formulate searchable, clinical questions in the PICO(T) format for your nursing clinical issue.

Next, review the guidelines for the PICOT Assignment due Week 3. Use your PICOT elements to search for one report of a single, original study that has been published within the last 5 years from the CCN Library that is relevant to your nursing clinical issue. Briefly, describe how it is relevant to your nursing clinical issue. Remember to give a complete reference to the study. Post your PICOT and research article in this discussion.

Remember to integrate references.

Class, please remember, you must answer this question by end of Wednesday to gain participation points. 

I have been an Emergency Department (ED) nurse for seven years. Many people ask why I would want to work in the ED.  The answer is simple.  I like being the first line of care for the patient.  I like that I don’t have time to build a relationship with the patient and the family.  Some may think that sounds cold, but I am one who would take the relationship home with me.  By that, I mean that if I developed a relationship with the patient and family members, it would hurt too much when illness or death overcame the patient.  I would not be able to leave that at work.  I need for my interactions with the patient to be completely medical.  Do I ever get emotionally attached to repeat patients?  Of course but, it is less common in the ED than it would be on an inpatient unit. The nature of ED nurses is often based on the need to provide emergency care. Many of the nurses I have discussed this with feel the same way.  They are too compassionate to allow themselves to become close to the patient.  Also, many of us feel that we have lost some of our faith in the human race because of our roles in the ED.  Because we often only have contact with the patient for a short period of time and we see many patients over and over, many of us suffer from compassion fatigue. The significant clinical issue that effects my department is compassion fatigue. Evidence-Based Practice or “EBP, considers internal and external influences on practice and encourages critical thinking in the judicious application of evidence to the care of the individual patient, patient population, or a system” (Hain, & Kear, 2015, p 12).

Click here to ORDER an A++ paper from our Verified MASTERS and DOCTORATE WRITERS NR 439 Discussion Search for Literature and Levels of Evidence:

My PICOT would be:

P – The population of interest for this project is registered nurses who worked in the Emergency Department full time

I – The intervention is educational training about compassion fatigue.  The intervention takes place off the unit and during a scheduled work tour.

C- The comparison is a survey taken by RNs prior to the education.

O- The outcome is reduction of compassion fatigue after the education.

T- The time frame is 6 months.

At 6 months, ED RNs take the same survey and values are compared. “Clinicians must critically evaluate research before attempting to implement the findings into practice” (Peterson,, 2014, p 67).

My PICOT question is “Are RNs who work in the ED, who are educated about compassion fatigue, less likely to suffer from CF?”

According to the article I found, “compassion fatigue (CF) is a relatively recent concept that refers to the emotional and physical exhaustion affecting healthcare providers, usually as a consequence of caring” (Hamilton, Tran, & Jamieson, 2016, p 1).  The article goes on to state that nurses have been more vocal than doctors about the effects of compassion fatigue over the years.  It also states that the ED is a breeding ground for CF.

NR 439 Discussion Search for Literature and Levels of Evidence
NR 439 Discussion Search for Literature and Levels of Evidence

This article is extremely relevant to my clinical question. As with any other issue, education is usually key to prevention and treatment. 


Hain, D. J., & Kear, T. M. (2015). Using evidence-based practice to move beyond doing                things the way we have always done them. Nephrology Nursing Journal42(1),                11–21.

Hamilton, S., Tran, V. & Jamieson, J. (2016). Compassion fatigue in emergency                           medicine: The cost of caring. Emergency Medicine Australasia, 28(1), 100-103.               doi:1111/1742-6723.12533

Houser, J. (2018). Nursing research: Reading, using, and creating evidence (4th ed.). Sudbury, MA: Jones & Bartlett. Peterson, M. H., Barnason, S., Donnelly, B., Hill, K., Miley, H., Riggs, L., & Whiteman, K.            (2014). Choosing the best evidence to guide clinical practice: Application of AACN levels of evidence. Critical Care Nurse, 34(2), 58–68. doi:10.4037/ccn2014411

Good evening, enjoyed reading your post as I was educated about this particular issue. I have never really heard of this so thank you so much for choosing this issue to share. I must admit that at first I thought you were not a caring nurse but as I read on and you explained why you have an unattachment to your patients it then made sense of what you need to do your job effectively. I discovered an article that may assist with the question you pose on it educating ER Nurses about CF. There are public tools available to measure compassion fatigue It states “These recognized tools may be utilized by staff to evaluate their compassion fatigue. Tools may be considered by organizations to investigate the trends within units or specialties. The Professional Quality of Life Scale (ProQOL) by Stamm (2005) is a 30 item free self-report tool accompanied by a self-score document to provide interpretation.  The Green Cross Academy of Traumatology website provides the Secondary Traumatic Stress Scale (STS) and the Compassion Fatigue Self-Test for Helpers (CFST).Both utilize self-report liked items to determine scores related to compassion fatigue, compassion satisfaction, and burnout levels or risks.” Carter,C (2013). Case Study: Compassion Fatigue Among Emergency Department Staff: A Patient Safety Consideration. Thank you for sharing this issue as it was informative.


Recently, my clinic was in-serviced on patient safety related to the prevention of fall and injury while using the restroom. Dialysis patients are at increased risk for falls before, during and after dialysis, because of various factors, including medical reasons, and comorbidities.

Here is my PICO for this situation:

P – prevent falls and injury of dialysis patients during the use of the restroom
I – monitor for falls by instructing patient to use call light, staying in close proximity of restroom, and call patient frequently to ensure safety
C – Pt safety compromised while the patient is in restroom
O – The patient will not fall and experience injury while in restroom

T – There will be no bathroom falls within 60 days

Key words here are fall, injury, safety, and prevention

Searchable question: what safety measures can be implemented to prevent patient falls and inury while the patient is in the restroom?

The situation in my clinic that relates to this PICOT is monitoring patients for falls which may result in injury or a medical emergency, in the restroom of the clinic. According to Cable and Schub (2016), a plan which is “designed to anticipate a patient’s risk for falling and provide interventions to reduce the risk”, has to be designed. The what, how, where and who are the questions suggested being addressed when looking at the plan of interventions for fall. Cable and Schub also gave the factors to be considered to prevent falls. These are in the acronym of D.A.M.E., 
D.A.M.E. stands for the drugs patients used, the age of patients, the medical factors or conditions of the patients, and the environment. All these factors have a significant effect on the population of patients in my clinic. Patients on dialysis may be hypotensive during treatment, many are elderly, and have medical conditions or comorbidities that may cause instability or unsteady gait, and altered mental status. The environment is what the E stands for. The area of treatment has to be free from obstruction like equipment, the bed has to remain lower, and lighting has to be adequate, among other environmental factors.
However, even though we have a policy and procedure in place for falls, the Education nurse provided an in-service on the restroom-fall policy and procedure. The purpose is to educate staff on monitoring patients when they go to the restroom. Because of patients’ susceptibility to falls, which may result in injury and medical emergency, and based on the factors mentioned, the clinic added to its fall precaution policy and procedures measures to monitor patients in the restroom. Patients are to be closely monitored, with staff standing outside of restroom and calling out to check on patients frequently.

Schubt and Heening(2016), gave the statistical breakdown of elderly patients falls. They stated falls can lead to severe complications.Because of this, they stated that clinicians need to learn about accidental falls and use an environmental checklist to ensure safety.

Caple, C.; Schub, T. (2016). Fall Prevention Plans: Implementation. Cinahl Nursing Guide. EBSCO Publishing ( Ipswich, Massachusetts), 2016 Jan 22 Retrieved from:

Schubt, T., Heening, H. (2017). Falls, Accidental: Resulting in Injury. Cinahl Nursing Guide. EBSCO Publishing(Ipswich, Massachusetts), 2016 June 17. Retrieved from:

     In my current role as Assistant Director of an inpatient surgical unit we strive to have the best possible patient outcome. In our ever changing health care system more and more focus is on how to decrease hospital stay and decrease patient recovery time.  My focus for this assignment will be same day surgery for total joint replacement.  Question: Can patients successfully recover from a total joint procedure if discharged same day?

P = Joint replacement patients

I= discharged same day surgery

C= previous inpatient joint replacement patients through chart review.

O= successfully recovery after surgery with no readmissions related to joint replacement.

T= 3 months

Searchable terms would be same day surgery, pain management for joint replacement, and home care after joint replacement.


Houser, J. (2015). Nursing research: reading, using and creating evidence (3rd ed.). Burlington, MA: Jones and Bartlett Learning.

Queen, K. H. (2015, July 20). Outpatient joint replacement at white fence surgical suites patients safely return home the same day after hip knee and shoulder surgery. Forbes196(1), 56-57. Retrieved from

1. I am a rehab case manager and I was a floor nurse on the rehab unit. We had a problem with keeping up with the details and updates to patients bladder and bowel programs for patients with spinal cord injuries, back injuries, strokes, and other injuries.

P: Patients with problem with bowel and bladder. Cannot void or have bowel movement on their own due to retention, spinal injury, constipation, immobility of bowel, or other problems. 

I: Bladder program that entails doing an ICP program that is bladder scanning every 4 to 6 hours, if the scan shows the amount is 300 mL full then inserting a straight catheter to drain the bladder is needed to empty the bladder, this is called bladder retraining. Bladder medications are started to help the patient’s bladder to void on their own. Some of these need to be tapered up to increase the dose every 3 days. Also, encourage patients to go to the bathroom at least every 2 hours. Bowel program that entails doing a daily suppository, with digital stimulation at the same time everyday, taking regular stool softeners, and make sure the patients have a BM daily. 

C: The alternative is no treatment, and the patient may show signs of Automomic Dysreflexia, from no use of bowel and bladder. 

O: Control of bowel and bladder with the above interventions. 

T: Programs need to be done every 4-6 hours and daily. 

For patients with spinal cord injuries, back injuries, strokes, and other injuries, what is the best routine for a bladder and bowel program to prevent complications? 

2.  F. Le Breton, A. Guinet Lacoste, P. Manceau, D. Verollet, G. Amarenc. Therapeutic education program for intermittent catheterization. Annals of Physical and Rehabilitation Medicine, Volume 57, 2014, Page e58. Received from

Ozisler, Z., Koklu, K., Ozel, S., & Unsal-Delialioglu, S. (2015). Outcomes of bowel program in spinal cord injury patients with neurogenic bowel dysfunction. Neural Regeneration Research10(7), 1153–1158. Received from 

3. The first article about bladder control with intermittent cath program shows that many forms of knowledge are needed to do this skill, whether it be “motor, sensory and visual possibilities, coordination, motor schema programmation, movement performance and cleanliness.” 

The second article is about way to control neurogenic bowel dysfunction in spinal cord injury patients. It also tells what interventions they used to help control the bowel programs. 

Both these articles use some of the same interventions we use in our nursing practice on the rehab unit where I work. 

Revised PICOT:

1. I am a rehab case manager and I was a floor nurse on the rehab unit. We have a problem with keeping up with the patients that need a toileting programs with patients that are incontinent at the time of care. 

P: Patients with problem bladder and bowel incontinence. Void or have bowel movement on their own due to urgency, frequency, stress, overflow, forgetfulness about needing to go due to dementia, or waiting of staff assistance to the bathroom.

I: The nurse is to start a toileting program, where the patient is taken to the bathroom every 2 hours whether the patient fills the need to void or not. This will help to get the patient on a schedule where they will hopefully become continent with some help, and start the toileting program on their own.

C: The alternative is no treatment, and the patient may show signs of bladder and bowel incontinence. 

O: Reduce or eliminate the amount of incontinent episodes during a shift, and 24 hour period.

T: Programs need to be done every 2 hours daily.

For patients with bladder and bowel incontinence, what is the best routine for staff to get every patient on the unit to bathroom every 2 hours?

2. Lappen, D., Berall, A., Davignon, A., Lancovitz, L., & Karuza, J. (2016). Evaluation of a Continence Implementation Program on a Geriatric Rehabilitation Unit. Perspectives: The Journal Of The Gerontological Nursing Association39(1), 24-30. Received from (Links to an external site.).

3. The article is about bladder training with a toileting program, using different survey tools to evaluate the patient’s needs to the program, and help the nursing staff to participate in the interventions themselves. According to Lappen, Berall, Davignon, Lancovitz, and Karuza (2016), “This was a program evaluation initiative to assess the implementation of the prompted voiding intervention and understand the barriers and facilitators of introducing continence care guidelines. This evaluation demonstrated the need for Plan-Do-Study-Act cycles to ensure that optimum uptake of best practices is integrated with the clinical team’s processes in delivering patient care” (p. 29).

P.S. Dr. Joy please give me feedback on this revised PICOT, if this is more appropriate for the Week 3 assignment.